Cross-border healthcare-seeking and utilization behaviours among ethnic minorities: exploring the nexus of the perceived better option and public health concerns.

BACKGROUND: Many ethnic minorities in Hong Kong seek medical tourism after encountering inequalities in access to local healthcare because of language barriers and cultural-religious differences. The present study explored the ethnic minorities' lived experiences of medical tourism and issues arising from cross-border health-seeking relevant to this specific population. METHODS: Qualitative in-depth interviews with 25 ethnic minority informants from five South Asian countries in 2019. RESULTS: The 19 informants out of the 25 have sought assistance from their international networks for home remedies, medical advice and treatments of traditional/Western medicines, for they are more costly or unavailable in Hong Kong and for issues related to racial discrimination, language barriers, transnationalism engagement, cultural insensitivity, and dissatisfaction with healthcare services in Hong Kong. DISCUSSION: Medical tourism can relieve the host country's caring responsibilities from healthcare services, so the government might no longer be hard-pressed to fix the failing healthcare system. Consequently, it could cause public health concerns, such as having patients bear the risks of exposure to new pathogens, the extra cost from postoperative complications, gaps in medical documentation and continuum of care, etc. It also triggers global inequities in health care, exacerbating unequal distribution of resources among the affordable and non-affordable groups. CONCLUSION: Ethnic minorities in Hong Kong sought cross-border healthcare because of structural and cultural-religious issues. The surge of medical tourism from rich and developed countries to poor and developing countries may infringe upon the rights of residents in destination countries. To mitigate such negative impacts, policymakers of host countries should improve hospital infrastructure, as well as train and recruit more culturally sensitive healthcare workers to promote universal health coverage. Healthcare professionals should also strive to enhance their cultural competence to foster effective intercultural communication for ethnic minority groups.

The role of minority stress in disordered eating: a systematic review of the literature.

PURPOSE: Sexual and gender minorities (SGMs) show a heightened risk of disordered eating compared to heterosexual and cisgender people, a disparity which may be caused by exposure to minority-specific stressors, such as discrimination and violence. This systematic review aims to summarize available evidence on the role of minority stress in disordered eating and SGM-specific aspects. METHODS: Following PRISMA guidelines, scientific search engines (EBSCO, PUBMED, Web of Science) were screened up to 31st of January 2024, including English-language original research papers containing analyses of the relationship between minority stress and disordered eating. 2416 records were gathered for screening. After application of inclusion and exclusion criteria, thematic analysis was conducted regarding 4 research questions: effects of minority stress on disordered eating, mediating factors, specificities of SGMs and differences between identity categories. RESULTS: 30 studies were included. Several aspects of minority stress are reliably associated with different forms of disordered eating. The relationship between minority stressors and disordered eating is mediated by aspects such as shame, body shame, or negative affect. SGMs show several specificities, such as the presence of a role of LGBTQIA + communities and additional gender-related pressures. Bisexual people and gender minorities appear to feature comparatively higher risks, and gender-related factors shape paths leading to disordered eating risk. CONCLUSION: Minority stress is an important predictor of disordered eating, making SGM people's health particularly at risk. Institutional and organizational anti-discrimination policies are needed, as well as further research. Clinical interventions may benefit from exploring and incorporating how minority stressors impact SGM people. Evidence level I-Systematic review.

Food Purchasing Behavior of Predominantly Minority Families in an Urban Supermarket Voucher Pilot Program.

The objective of this exploratory community-based trial was to examine the usage and behavior of underserved urban residents participating in a 2-month food voucher program. $70 supermarket vouchers were provided each month for 2 months to participants enrolled in selected child daycare centers in East Harlem, New York, and receipts were collected to examine purchases. Participants were from low-income households with at least 1 child 5 years and younger (n = 113). Participants spent the most on meat, fish, poultry, and eggs (29.7%); fruits and vegetables (15.9%); and cereal and bakery products (15.1%). Fruit and vegetable purchases and dairy purchases were higher in foreign-born participants than in US-born participants. Furthermore, future models should consider the potential benefit of unrestricted vouchers in supporting differences in dietary needs and preferences.

Ethnic and national identification of minority youth in China: The mediating role of intergroup orientation.

This study examined the mediating role of intergroup orientation in the relationship between ethnic and national identification. Our participants were 1320 Yi minority youths from a secondary school located in the Yi ethnic autonomous prefecture of southwest China. The participants completed three self-report questionnaires measuring ethnic and national identification, and intergroup orientation, respectively. Structural equation modeling was employed to determine the relationships between ethnic and national identification and intergroup orientation, and to explore the mechanism underlying the association between ethnic and national identification. The results showed that Yi minority youths with a stronger sense of ethnic identity had a stronger sense of national identity. The results further indicated that stronger ethnic identity led to a more positive intergroup orientation, which in turn predicted a stronger national identity. Our findings may facilitate the cultivation of positive attitudes between national subgroups in multiethnic countries and help ethnic minority youth develop a stronger awareness of national identity while retaining their ethnic identity.

Identifying barriers to outpatient appointment attendance in patient groups at risk of inequity: a mixed methods study in a London NHS trust.

BACKGROUND: There is significant health inequity in the United Kingdom (U.K.), with different populations facing challenges accessing health services, which can impact health outcomes. At one London National Health Service (NHS) Trust, data showed that patients from deprived areas and minority ethnic groups had a higher likelihood of missing their first outpatient appointment. This study's objectives were to understand barriers to specific patient populations attending first outpatient appointments, explore systemic factors and assess appointment awareness. METHODS: Five high-volume specialties identified as having inequitable access based on ethnicity and deprivation were selected as the study setting. Mixed methods were employed to understand barriers to outpatient attendance, including qualitative semi-structured interviews with patients and staff, observations of staff workflows and interrogation of quantitative data on appointment communication. To identify barriers, semi-structured interviews were conducted with patients who missed their appointment and were from a minority ethnic group or deprived area. Staff interviews and observations were carried out to further understand attendance barriers. Patient interview data were analysed using inductive thematic analysis to create a thematic framework and triangulated with staff data. Subthemes were mapped onto a behavioural science framework highlighting behaviours that could be targeted. Quantitative data from patient interviews were analysed to assess appointment awareness and communication. RESULTS: Twenty-six patients and 11 staff were interviewed, with four staff observed. Seven themes were identified as barriers - communication factors, communication methods, healthcare system, system errors, transport, appointment, and personal factors. Knowledge about appointments was an important identified behaviour, supported by eight out of 26 patients answering that they were unaware of their missed appointment. Environmental context and resources were other strongly represented behavioural factors, highlighting systemic barriers that prevent attendance. CONCLUSION: This study showed the barriers preventing patients from minority ethnic groups or living in deprived areas from attending their outpatient appointment. These barriers included communication factors, communication methods, healthcare the system, system errors, transport, appointment, and personal factors. Healthcare services should acknowledge this and work with public members from these communities to co-design solutions supporting attendance. Our work provides a basis for future intervention design, informed by behavioural science and community involvement.

Predicting aggressive behaviors: Examining unique and interactive roles of PTSD and emotion dysregulation in a minority sample.

Aggression is a costly public health problem with severe and multi-faceted negative consequences and thus, identifying factors that contribute to aggression, particularly in understudied populations, is necessary to develop more effective interventions to reduce the public health cost of aggression. The goal this study was to test whether difficulties regulating emotions moderated the association between posttraumatic stress disorder (PTSD) symptoms and aggression in a community sample of predominantly Black females with high levels of trauma exposure. Furthermore, we explored unique relations between PTSD symptom clusters and distinct subscales of difficulties regulating emotions and aggression. The sample included 601 community participants recruited from an urban public hospital. Symptoms were assessed using self-report measures including the Difficulties in Emotion Regulation Scale (DERS) and Behavioral Questionnaire-Short. Regression analyses were conducted using PTSD symptoms and total DERS to test their interaction as predictors for aggression (using BQ-Short). We found that higher levels of PTSD arousal symptoms and difficulty controlling impulses when upset were positively related to aggression. We also conducted an exploratory analysis to examine the association between PTSD symptom clusters using the Alternative Symptom Clusters hybrid model. The results suggest that some PTSD symptoms (externalizing behavior) and some emotion dysregulation processes (difficulties controlling impulses when upset), relate to aggression in independent, rather than multiplicative ways. These results offer insights for new directions of research that focuses on the independent association between specific emotion dysregulation processes and PTSD symptoms on aggression.

Power Dynamics Perpetuate DEI Inaction: A Qualitative Study of Community Health Clinic Teams.

PURPOSE: Despite increased clinician awareness of systemic racism, lack of substantial action toward antiracism exists within health care. Clinical staff perspectives, particularly those of racial-ethnic minorities/persons of color (POC) who disproportionately occupy support staff roles with less power on the team, can yield insights into barriers to progress and can inform future efforts to advance diversity, equity, and inclusion (DEI, also referred to as EDI) within health care settings. This qualitative study explored the perspectives of staff members on race and role power dynamics within community health clinic teams. METHODS: We conducted semistructured 45-minute interviews with staff members working in community health clinics in a large urban health care system from May to July 2021. We implemented purposeful recruitment to oversample POC and support staff and to achieve equal representation from the 13 community health clinics in the system. Interviews were audio recorded, transcribed, and analyzed over 6 months using a critical-ideological paradigm. Themes reflecting experiences related to race and role power dynamics were identified. RESULTS: Our cohort had 60 participants: 42 (70%) were support staff (medical assistants, front desk clerks, care navigators, nurses) and 18 (30%) were clinicians and clinic leaders. The large majority of participants were aged 26 to 40 years (60%), were female (83%), and were POC (68%). Five themes emerged: (1) POC face hidden challenges, (2) racial discrimination persists, (3) power dynamics perpetuate inaction, (4) interpersonal actions foster safety and equity, and (5) system-level change is needed for cultural shift. CONCLUSIONS: Understanding the race and role power dynamics within care teams, including experiences of staff members with less power, is critical to advancing DEI in health care.

The anatomy of prejudice during pandemic lockdowns: Evidence from a national panel study.

During the early stages of the COVID-19 pandemic, there was a spike in the reporting of hate crimes (Human Rights Watch, 2020). However, the extent to which the pandemic affected prejudice across a general population-not merely among those disposed to hate crimes-remains unclear. Also unclear is the extent to which prejudice was restricted to specific minority groups associated with the virus, or whether prejudice spilled over to other minority groups. To address these questions, we use panel data collected from participants in a large national longitudinal (panel) study of New Zealanders before and during the early COVID-19 pandemic and systematically quantified social warmth ratings across a broad range of minority-groups (The New Zealand Attitudes and Values Study, N = 30,327, years 2018-2020). We discover reduced warmth toward Chinese, Asians (broadly defined), immigrants, Muslims, refugees, Indians, and the mentally ill. In absolute terms, warmth towards Chinese decreased the most (0.11 SD). Notably, changes in warmth were not detected toward NZ Europeans, Maori, Pacific Islanders, the overweight, or the elderly. Overall, these findings suggest that in New Zealand, pandemic prejudice may spread beyond minority groups associated with the virus to other groups perceived as non-prototypical of national identity.

Zoom out: An intervention on the virtual learning environment improves minority students' grades in two field experiments in Israel.

Closing the achievement gap for minority students in higher education requires addressing the lack of belonging these students experience. This paper introduces a psychological intervention that strategically targets key elements within the learning environment to foster the success of minority students. The intervention sought to enhance Palestinian minority student's sense of belonging by increasing the presence of their native language. We tested the effectiveness of the intervention in two field experiments in Israel (n > 20,000), at the height of the COVID-19 pandemic when all classes were held via Zoom. Lecturers in the experimental condition added a transcript of their names in Arabic to their default display (English/Hebrew only). Our findings revealed a substantial and positive impact on Palestinian student's sense of belonging, class participation, and overall grades. In experiment 1, Palestinian student's average grade increased by 10 points. In experiment 2, there was an average increase of 4 points among Palestinian students' semester grade. Our intervention demonstrates that small institutional changes when carefully crafted can have a significant impact on minority populations. These results have significant implications for addressing educational disparities and fostering inclusive learning environment.

Exploring the mechanisms underlying increased risk of depressive disorder in ethnic minority populations in Europe: A causal loop diagram.

BACKGROUND: Multiple ethnic minority populations in Europe show high risk of major depressive disorder (MDD), with ethnic discrimination and low socioeconomic position (SEP) as established risk factors. How this risk is shaped by the interactions between these, and other social factors, remains to be elucidated. We aimed to develop a causal-loop diagram (CLD) to gain a better understanding of how factors at the intersection of ethnic discrimination and SEP dynamically interact to drive MDD risk. METHODS: We iteratively mapped the interactions and feedback loops between factors at the intersection of ethnic discrimination and SEP, drawing input from (i) a series of two interviews with a range of MDD domain experts, (ii) an existing CLD mapping the onset of MDD across psychological, biological, and social dimensions at the level of the individual, and (iii) other relevant literature. RESULTS: Through tracing the feedback loops in the resulting CLD, we identified ten driving mechanisms for MDD onset in ethnic minorities (two related to ethnic discrimination, SEP, social network and support, and acculturation, as well as one relating to the living environment and self-stigma towards MDD); and four factors that modulate these mechanisms (recent migration, religious affiliation, neighborhood social environment, and public stigma towards MDD). The intersecting nature of ethnic discrimination and SEP, combined with the reinforcing dynamics of the identified driving mechanisms across time- and spatial scales, underscores the excess exposure to circumstances that increase MDD risk in ethnic minorities. CONCLUSIONS: While this CLD requires validation through future studies, the intersecting and reinforcing nature of the identified driving mechanisms highlights that tackling the high risk of MDD in ethnic minorities may require intervening at multiple targets, from the individual (e.g., psychological interventions targeting negative beliefs or reducing stress) to the societal level (e.g., addressing labor market discrimination).

Redefining the term "Disadvantaged student": A post baccalaureate program's role in underrepresented students' success and reclaiming of narratives.

PURPOSE: Racial/ethnic minority groups and low-income students continue to be underrepresented in medicine (URiM) despite years of diversity and inclusion efforts. Post baccalaureate programs (PBP) are shown to prepare underrepresented students to successfully matriculate to medical school. However, identification of the aspects of a PBP that are key to future success in medicine from the student perspective is lacking. Therefore, this study was designed to answer the question, "What aspects of a post baccalaureate program do URiM students see as valuable to their future success?" METHODS: This is a qualitative analysis of semi-structured interviews with alumni of the UCSF PBP who completed the program between 2015-2020. Interviews were conducted via phone or video call, audio recorded, and transcribed verbatim. Names and years of attendance were removed from the transcripts prior to review to protect confidentiality. Transcripts were coded following an inductive qualitative approach using methodology rooted in grounded theory. Demographic data was collected upon enrollment in the program. RESULTS: Forty study participants were interviewed (58% of eligible subjects). Participants self-identified as Latinx (70%), African American (8%), Southeast Asian (10%), Native American (2%), Multiethnic (10%), and 60% female. The average age at enrollment was 24 years. Most participants (75%) were first-generation college students and 85% grew up with a family income <$49,999. Qualitative findings were categorized into five main themes: (1) Academic, Professional, and Personal Skills Development, (2) Supportive Student Cohort, (3) Resources, Personalized Advising, and Mentorship, (4) Gaining Confidence and a Sense of Belonging in Medicine, and (5) Redefining "Disadvantaged" Status. A novel finding was the importance of redefining the narrative of belonging to a "disadvantaged" community. During the program, the study participants reported gaining confidence and a sense of belonging in medicine as they recognized the unique qualifications and advantages they bring to medicine. CONCLUSIONS: Our findings suggest that in addition to academic preparation, PBPs for students who are underrepresented in medicine should empower students to recognize their strengths and qualifications in the field of medicine. Our study participants rejected the term "disadvantaged" as they celebrated the value of their backgrounds and what they bring to medicine.

Maternity care for women from ethnic minority backgrounds in North-West England: A grounded theory study.

AIM: To understand the maternity experiences of women from minority ethnic groups who had given birth in an NHS trust in the North-West of England, and experiences of midwives caring for them. BACKGROUND: Women from minority ethnic groups have poorer maternity outcomes compared with other women. Research about maternity experiences of women from minority ethnic groups is limited but suggests that they have poorer experiences. METHOD: Constructivist grounded theory was used as the framework for the study. Thirteen women and sixteen midwives were interviewed to elicit views and maternity experiences of women from minority ethnic groups. Interviews were transcribed, analysed, and focused codes developed into theoretical codes resulting in an emergent grounded theory. FINDINGS: Four sub-categories emerged: 'I was feeling protected', 'it is just literally empowering them, 'it will affect them more', and 'if people speak out it will help other people'. These sub-categories generated a substantive theory: 'striving towards equity and women centred care'. DISCUSSION: Culturally sensitive, relational care made women feel safe and trust their care providers. Information provision led to reassurance and enabled women to make choices about their care. Midwives' workload compromised care provision and disproportionally affected women from minority ethnic groups, especially those who do not speak English. Women from minority groups are less likely to complain and be represented in feedback. CONCLUSION: Culturally sensitive care is meeting the individual needs of many women; however, non- English speakers are disproportionally and negatively affected by midwives' workload, attitudes, or service challenges, reducing their reassurance and choice.

Exploring experiences with alcohol and how drinking has changed over time among minority ethnic groups with a diagnosed mental health problem.

INTRODUCTION: Minority ethnic groups are more likely to experience poor mental health but less likely to seek formal support. Mental health problems and alcohol use (including non-drinking) co-occur, the reasons for this among minority ethnic groups are not well understood. This study explored i) alcohol use among minority ethnic individuals with a mental health problem,ii) how alcohol was used before individuals received support for their mental health,iii) how alcohol changed whilst and after individuals received treatment for their mental health. METHODS: Participants were purposively sampled through community/online mental health organisations. Participants took part if they i)were not White British, ii) had a mental health diagnosis, iii) drank at hazardous and above levels or former drinkers. Telephone/online semi-structured interviews were conducted. Data were analysed using framework analysis with an intersectional lens. RESULTS: 25 participants took part. Four themes were developed; "drinking motivations", "mental health literacy and implications on drinking behaviour", "cultural expectations and its influence on mental health problems and drinking practices", and "reasons for changes in drinking". Themes reflect reasons for drinking and the role of understanding the range of mental health problems and implicit cultural expectations. An intersectional lens indicated gendered, ethnic and religious nuances in experiences with alcohol and seeking support. Engaging with formal support prompted changes in drinking which were facilitated through wider support. CONCLUSION: There were specific reasons to cope among minority ethnic individuals who have a mental health problem. Applying an intersectional lens provided an insight into the role of cultural and gendered expectations on mental health and drinking practices. Mental health literacy and implicit cultural expectations within specific minority ethnic groups can affect both mental health and drinking practices. Healthcare professionals and wider community play an important role in prompting changes in drinking among minority ethnic groups who have a mental health problem.

Vaksinenøling under koronapandemien blant unge med etnisk minoritetsbakgrunn i Oslo øst ­ en kvalitativ studie.

Background: Few studies have been conducted on young people's attitudes to the COVID-19 vaccine during the pandemic. We wished to examine how young people with an ethnic minority background decided whether to have the COVID-19 vaccine, based on the concept of vaccine hesitancy. Vaccine hesitancy involves uncertainty with regard to vaccination, irrespective of the decision taken. Material and method: Fourteen qualitative in-depth interviews with young people aged 16-25 years with an ethnic minority background and from the east side of Oslo were analysed and categorised into main themes. The participants also had links to the Middle East, South Asia and Africa. Results: Several of the study participants were hesitant to be vaccinated. Their hesitation was linked to the impression that the vaccine had been developed rapidly, false rumours, long travel times to vaccination centres and fear of adverse effects. A number called for better information. Vaccination through the school was described as a facilitating factor. Family and friends were less crucial in their assessment of whether to have the COVID-19 vaccine. The majority had trust in the authorities. Interpretation: Insufficient knowledge about the vaccine and fear of adverse effects, as well as practical barriers associated with undergoing vaccination, appears to contribute to vaccine scepticism among young people with an ethnic minority background. The authorities and healthcare personnel should provide young people with better vaccine information. Information should be provided by personnel they already trust, such as the school nurse.

Minority Student Perceptions of the Impact of Financial Cost of Pharmacy School and Career Choice at a Historically Black College and University (HBCU).

OBJECTIVE: One of the barriers that might prevent an underrepresented minority (URM) individual from pursuing a professional career in the United States is finances. The high disproportionate burden of student debt among URM students further perpetuates the racial wealth gap. Therefore, this study sought to evaluate the extent to which URM students' personal finance perceptions, and current and projected student loan indebtedness affect postgraduation career intentions. METHODS: A cross-sectional analysis was conducted using data from four cohorts of pharmacy students using a survey from November 2, 2022, to February 1, 2023. The financial perception survey included subscales namely personal finance self-efficacy, debt influence and pressure, and risk mitigation and retirement. Descriptive statistics, simple logistic regression, and multivariate logistic regression analyses were conducted. RESULTS: In total, 93 students completed the survey and had a mean age of 28.1 ± 5.3 years. Seventy-one percent of the respondents were female, and 67.7 % had completed a 4-year bachelor's degree. There was a significant association between age and the intention to pursue postgraduate training as well as a significant association between risk mitigation and retirement perceptions and intention to pursue postgraduate training after adjusting for other factors. CONCLUSION: Among students from largely minority backgrounds, age, and confidence in their ability to make wise investment decisions for retirement are associated with a greater likelihood of pursuing postgraduate training opportunities.

Family Functioning, Identity Commitments, and School Value among Ethnic Minority and Ethnic Majority Adolescents.

Ethnic minority youth show worse school adjustment than their ethnic majority peers. Yet, it remains unclear whether this gap can be explained by differences in family functioning and consequent identity commitments. This study examined (1) whether family functioning relates to identity commitments over time and (2) whether identity commitments impact later school value (3) among minority and majority adolescents. Minority (N = 205, Mage = 16.25 years, 31.1% girls) and majority adolescents (N = 480, Mage = 15.73 years, 47.9% girls) participated in this preregistered three-wave longitudinal study (T1: March-April 2012; T2: October 2012; T3: March-April 2013). Dynamic Panel Models revealed that most within-person cross-lagged associations were not significant in the total sample. Yet, multigroup analyses revealed differences between groups: Stronger identity commitments related to lower school value among minority adolescents, but were unrelated to school value among majority adolescents over time. Additionally, higher school value increased identity commitments among minority youth, yet it decreased identity commitments among majority youth over time. The findings highlight the differential interplay between identity commitments and school adjustment for minority and majority adolescents, with important implications for their future life chances.

Youth violence and knife crime in ethnic minorities in the UK: A review of the literature.

BACKGROUND: Youth violence and knife crime is increasing dramatically, so much so it has been described as a global epidemic. The social, economic and political forces fuelling this rise mean that minority groups are particularly affected. AIM: This paper reviews the literature primarily from a UK perspective, and illustrates the disparate factors that are influencing the rise in youth violence and knife crime and illustrates the complexities of integrating the perspectives of different disciplines into coherent intervention strategies. METHOD: We conducted a systematic review of the literature that explores both the causes of increasing youth violence and knife crime as well as some of the interventions that have attempted to deal with the problem. RESULTS: A complex interplay of social, economic, mental health and political factors underpin the increase in youth violence and knife crime. An uneasy tension exists between a traditional criminal justice system-based approach based upon deterrence and punishment, and a more liberal preventative model focusing on adolescent mental health. None of the interventions thus far have been particularly effective. CONCLUSION: Youth violence and knife crime is a global social issue that causes untold suffering to individuals, families and communities as well as fear that reverberates through society. Interventions have often been devised through the lens of particular disciplines or ideologies. Integrating these perspectives into a coherent approach that is actually effective demands greater co-operation, dialogue and mutual understanding between disciplines and agencies, as well as a robust framework for the evidence-based assessment of outcomes.